Forensic medicine is the application of medicine to the legal arena. It is a very broad area of study integral to the entirety of forensic science. While many subdisciplines of forensics have had to struggle for acceptance from judges and attorneys, medical evidence has enjoyed a long history of courtroom acceptance. The historical record indicates that medical evidence was presented in courtrooms dating back to Ancient Greece and China. Since the 1960s and the due process revolution, medical and forensic evidence has become increasingly important to the resolution of cases within the criminal justice system, since fewer cases are resolved by confessions and more are resolved by the presentation of physical evidence to the judge and jury.
Forensic medicine is divided into three general subareas: forensic pathology, forensic psychiatry; and forensic toxicology and serology. There are also a number of fields closely related to forensic medicine, including forensic odontology and anthropology and forensic biology, chemistry, and biochemistry.
Forensic Pathology
Pathology is the study of disease and injury from the causative aspect, as distinct from those branches of medicine that are concerned with the diagnosis and treatment of disease. Within pathology are numerous subspecialties such as hematology (the study of blood), microbiology (the study of bacteria and other microorganisms), clinical biochemistry, and histopathology. Forensic pathology, a subdiscipline of pathology, is the study of how and why people die, concentrating on sudden, unexpected, and violent deaths. During a homicide investigation, either a forensic pathologist or the medical examiner will conduct the autopsy, which includes a thorough interior physical examination of the body and specialized laboratory tests.
The medical examiner is a physician appointed in a particular jurisdiction to oversee death investigation. It is the responsibility of the medical examiner to lead the investigation of all deaths that are sudden, unexpected, or violent, and make a determination as to the time, manner (natural, accident, suicide, homicide), and cause of death.
Initially, the colonies had a coroner system very much like the system that had been in place in Europe for 1,000 years. A coroner is an elected official who may or may not have medical training. Autopsies were carried out in Massachusetts prior to 1647. In 1666 coroners in Maryland were appointed by county. In the eighteenth century, Philadelphia became the major center of medical learning in colonial America with the first medical school being developed at the University of Pennsylvania. Prior to that time, physicians received training in Europe. In the late 1870s, growing dissatisfaction with the coroner system led jurisdictions to change to a medical examiner system. The first medical examiner, Frank W. Draper, was appointed in Boston. Draper also wrote a text topic on legal medicine in 1905. Currently about half of the U.S. population is served by a medical examiner. Those jurisdictions still using the coroner system are generally smaller, more rural areas. However, Pittsburgh, Pennsylvania, and its surrounding Allegheny County still use a coroner system. While Allegheny County’s coroner is an elected official, individuals in this position have long since been medical doctors.
It is the primary duty of the medical examiner to establish the time, manner, and cause of death. Frequently, time of death is not in question, because most deaths are witnessed. It is only when a death is not witnessed that the question of time of death becomes important. Time of death can be established by looking at the interval between the time when the individual was last seen alive and the time when the body was found. The larger this interval, the more difficult it is to accurately pinpoint the time of death. The manner of death refers to whether the individual died of natural causes, accident, suicide, or homicide. Often, this is not a difficult question, but a suicide is not always clearly a suicide, and a perpetrator may attempt to disguise a homicide. The medical examiner will determine both the immediate and proximal causes of death. The immediate cause is the last event prior to a death, which may happen hours or days before death. The proximal cause of death is the first event leading up to a death, which may have been evident in the individual for years prior to death.
In a homicide investigation, the body is usually the single most important piece of evidence that will be processed. Also, the area surrounding the body will generally contain most of the forensic evidence in the case. The medical examiner may also be called upon to testify in a civil or criminal courtroom regarding the findings from the completed investigation.
Medical examiners have received a medical degree and frequently have received advanced training in pathology (the study of disease mechanisms and death) and forensic pathology (the study of how and why people die). They also generally acquire knowledge in a variety of fields related to forensic medicine, for example, ballistics, serology, and DNA analysis.
Forensic Psychiatry
Forensic psychiatrists combine knowledge and practical experience in medicine, mental health, the neurosciences, and the law. The vast majority of work that forensic psychiatrists (and psychologists) perform is on the civil side of the law and deals with product liability, custody issues, and competency to handle personal affairs.
In the criminal court, forensic psychiatrists may testify regarding issues of sanity and competency. Sanity refers to an individual’s state of mind during the commission of a crime. Competency generally refers to competency to enter a plea, competency to stand trial, and competency to be executed.
A forensic psychiatrist may be called upon to construct an offender profile, or criminal personality profile. Offender profiling is a method of identifying the perpetrator of a crime based on an analysis of the nature of the offense, the victim, and the manner in which the crime was committed. It is typically used when there is little physical evidence that can be used to identify a suspect, when the crime is bizarre or appears to be serial in nature, or when murder with sexual overtones is committed.
A forensic psychiatrist may also be called upon to determine whether a sexual offender meets the statutory criteria to be deemed a violent sexual predator and subject to civil commitment. This evaluation takes into account the current offense and the statutory definition of ”violent sexual predator.”
Prior to any psychiatric evidence being presented in a courtroom, a forensic psychiatrist will conduct a thorough examination of the individual to evaluate mental status. The psychiatric testimony may also be supported by the results of psychological testing and neurological examination.
Forensic psychiatrists have received a medical degree and advanced training in psychiatry. Their knowledge of forensic psychiatry is acquired through working in a variety of forensic settings, including mental health facilities and prisons.
Forensic Toxicology and Serology
Forensic toxicology is concerned with chemicals (drugs and poisons) found in the human body. During a death investigation, forensic toxicologists may make a determination as to whether the victim was killed using a poison such as lead. Toxicology results can also determine whether a drug such as Rohypnol was used during a sexual assault.
Throughout history, poisons have been used to harm and kill. The Roman emperor Claudius may have been poisoned. During the fourteenth and fifteenth centuries, poisoning was quite common in Italy. There are numerous tales of poisoning involving the Borgia popes. Poisoning as a method of killing spread throughout Europe during the sixteenth, seventeenth, and eighteenth centuries. It was so common that it was universally feared by the nobility.
In the United States, the New York medical examiner’s office established the first toxicology laboratory in 1918. This predates the inception of the first forensic science laboratory. The American Board of Forensic Toxicology was founded in 1975.
Serologists are involved with the identification and processing of blood, semen, saliva, and other bodily fluids; they may also be involved in bloodstain, bloodspat-ter, and DNA analysis. These types of evidence may be crucial in sexual assault cases or during a homicide investigation.
Related Fields
There are many fields that are related to forensic medicine. Professionals in the fields of forensic odontology and forensic anthropology assist in the identification of bodies. Professionals in the fields of forensic biology, forensic chemistry, and forensic biochemistry frequently work in laboratories.
Forensic Odontology and Anthropology
Generally, forensic odontologists (dentists) and anthropologists will assist in the identification of a body that otherwise cannot be identified. It may be burned, in a significant state of decay, or even skeletonized. Forensic anthropologists are most frequently called upon when skeletonized remains are found. From these remains, the anthropologist will assist in identifying the victim and may also provide an approximate date and cause of death. Forensic anthropologists have a Ph.D. degree in anthropology.
Forensic odontologists compare ante-mortem dental records to present observations of dental characteristics in a body for the purpose of identifying the victim. They may also be called upon to link a suspect to bite marks left upon a living or dead victim. Forensic odontologists have completed dental school.
Forensic Biology, Chemistry, and Biochemistry
Individuals in the areas of forensic biology, forensic chemistry, and forensic biochemistry have received training in their primary disciplines, having received either a master’s or a Ph.D. degree. These individuals often specialize in more narrow areas, such as optics, microbiology, molecular biology, or genetics. Forensic chemists may work in forensic laboratories, analyzing mostly drug samples, which makes up the bulk of the work of forensic laboratories. Forensic biologists may work with biological samples that are received in a laboratory.
